Surgery Service, Veterans Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts.
Surgery Service, Charles George VA Medical Center, Asheville, North Carolina.
JAMA Surg. 2014 Nov;149(11):1182-7. doi: 10.1001/jamasurg.2014.1891.
Transit time flow (TTF) probes may be useful for predicting long-term graft patency and assessing grafts intraoperatively in patients undergoing coronary artery bypass grafting (CABG); however, studies of TTF probe use are limited.
To examine 1-year graft patency and intraoperative revision rates in patients undergoing CABG based on intraoperative TTF assessment.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a multicenter randomized clinical trial conducted at 18 Veterans Affairs hospitals using the Randomized On/Off Bypass (ROOBY) Trial data set. Of the original 2203 patients undergoing CABG surgery with or without cardiopulmonary bypass from February 1, 2002, through May 31, 2008, we studied a subset of 1607 who underwent TTF probe analysis of 1 or more grafts during surgery.
Use of TTF probes to assess graft flow and pulsatility index (PI) values. The decision to revise a graft was based on the judgment of the attending surgeon.
Rates of 1-year FitzGibbon grade A patency and intraoperative revision were compared based on TTF measurements (<20 [low flow] vs ≥20 mL/min [normal flow]) and PI values (<3, 3-5, and >5).
We measured TTF and/or PI in 2738 grafts, and 1-year patency was determined in 1710 (62.5%) of these grafts. FitzGibbon grade A patency occurred significantly less often in grafts with a TTF with low flow (259 of 363 [71.3%]) than in those with normal flow (1174 of 1347 [87.2%]; P < .01). FitzGibbon grade A patency was also inversely correlated with increasing PI values, as found in 936 of 1093 grafts (85.6%) with a PI less than 3, 136 of 182 grafts (74.7%) with a PI of 3 to 5, and 91 of 134 grafts (67.9%) with a PI greater than 5 (P ≤ .01). Intraoperative graft revision was more frequent in grafts with low flow (44 of 568 [7.7%]) than in those with normal flow (8 of 2170 [0.4%]; P < .01). Graft revision was also more frequent as PI increased (12 of 1827 [0.7%] with a PI <3, 9 of 307 [2.9%] with a PI 3-5, and 9 of 155 [5.8%] with a PI >5; P < .01).
Intraoperative TTF probe data may be helpful in predicting long-term patency and in the decision of whether to revise a questionable graft for patients undergoing CABG surgery.
在接受冠状动脉旁路移植术（CABG）的患者中，瞬变时间流量（TTF）探头可能有助于预测长期通畅率并在术中评估移植物；然而，对 TTF 探头使用的研究是有限的。
根据术中 TTF 评估，研究 CABG 患者的 1 年通畅率和术中再修复率。
设计、设置和参与者：对在 18 家退伍军人事务医院进行的多中心随机临床试验的回顾性分析，使用随机开/关旁路（ROOBY）试验数据集。在 2002 年 2 月 1 日至 2008 年 5 月 31 日期间接受 CABG 手术的 2203 例患者中，我们研究了其中的一个亚组 1607 例，这些患者在手术期间对 1 个或多个移植物进行了 TTF 探头分析。
使用 TTF 探头评估移植物的流量和搏动指数（PI）值。对移植物进行修订的决定基于主治外科医生的判断。
根据 TTF 测量值（<20[低流量]与≥20 mL/min[正常流量]）和 PI 值（<3、3-5 和>5），比较了 1 年菲茨吉本 A 级通畅率和术中再修复率。
我们测量了 2738 个移植物的 TTF 和/或 PI，在这些移植物中，1710 个（62.5%）确定了 1 年的通畅率。低流量 TTF 组（259 个/363 个[71.3%]）的菲茨吉本 A 级通畅率明显低于正常流量 TTF 组（1174 个/1347 个[87.2%]；P<0.01）。菲茨吉本 A 级通畅率也与 PI 值的升高呈负相关，在 1093 个移植物中有 936 个（85.6%）PI 值<3，182 个移植物中有 136 个（74.7%）PI 值为 3 到 5，134 个移植物中有 91 个（67.9%）PI 值>5（P≤0.01）。低流量（44/568 [7.7%]）的移植物术中再修复率高于正常流量（8/2170 [0.4%]；P<0.01）。PI 值增加时，移植物再修复率也更高（PI<3 时有 12/1827 [0.7%]，PI 为 3-5 时有 9/307 [2.9%]，PI 为 5 时有 9/155 [5.8%]；P<0.01）。
术中 TTF 探头数据可能有助于预测长期通畅率，并有助于决定是否对接受 CABG 手术的患者的可疑移植物进行修复。
